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38B-207 43 MANNAN ST BP-2020-0426 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38B-207 CITY OF NORTHAMPTON Lot:-001 1'I 1ZSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ROOF BUILDING PERMIT Permit# BP-2020-0426 Project# JS-2020-000726 Est.Cost: $7850.00 Fee: $40.00 PERMISSION IS HEREBY GRANTED TO.- Const. O:Const.Class: Contractor: License: Use Group: STEPHEN CAMP 082531 Lot Size(sq.ft.): 4399.56 Owner: KIERAS AUDREY M Zoning: URB(100)/ Applicant. STEPHEN CAMP AT. 43 MANNAN ST Applicant Address: Phone: l isurance: 46 EAST ST (413) 527-7124 O _ _W_ C EASTHAMPTONMA01027 ISSUED ON.101412019 0:00:00 TO PERFORM THE FOLLOWING WORK.-STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM.THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Budding Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeTvim Date Paid: Amount: Building 10/4/2019 0:00:00 $40.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner City of Northampton D Building Departme ` r 212 Main St i�Cj�1 v Roorry 10 ' Northampton', MA 01060rr�� _ 3 2p19 phone 413-587-1240 Fax 13W7-1272 - APPLICATION TO CONSTRUCT, ALTER REMM,,, �. DEMOLISH A ONE OR TWO FAMILY DWELLING .� nn SECTION 1 -SITE INFORMATION 1.1 Property Address: Thi section to be completed by office Map Lot '7_�O-7 Unit Zone Overlay District d^� Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: JQfJ�✓ ,�l A,5 Name(Print) Current Mailing Address: 3715- Telephone Signature r ' 2.2 Authorized Agent: Name(Print) Current Mailing Address: �zi Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) Vq0 5. Fire Protection 6. Totai = (1 +2+3 +4 +5) Check Number 2> This Section For Official Use Only BuildingPermit Number: Date Issued: Signature: J O � j I Building Commissioner/Inspector of Buildings Date Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage �— Setbacks Front Side L:= R:= L:= R:0 0 Rear 0 Building Height 0 Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved parking) #of Parking Spaces Fill: IF �1 ^� volume&Location 71 A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DON'T KNOW © YES Q IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO © DON'T KNOW 0 YES IF YES: enter Book Page and/or Document#�� B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained ® , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES © NO O IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. i SECTIONS-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition ❑ Replacement Windows Alteration(s) ❑ Roofing Or Doors D Accessory Bldg. ❑ Demolition ❑ New Signs [0] Decks Siding [0] Other[dl Brief Description of Proposed Work: y`c�i Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet , t a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO:BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT' as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date 5 GSC�Il� Owner/Authorize Agent hereby declare that the statementsandinformation on the foregoing application are true and accurate,to the es o my cnowledge and belief. Signed under the pains and penalties of perjury. Print Name l� 7 Signature of Owner/Agen Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Suppeervissor: Not Applicable ❑ Name of License Holder: r`�Sly A liO 2 5 �� License Number Address G,e-// Expiration Date Signature Telephone //'� Not Applicable ❑ LOQ �I�LIG�/c��t� Co pane Name Registration Number �l Y¢ �j`v�c.� -7-13— 0-C-17Address / Expiration Date 6� 7`k �ti DZO Z Telephone �2 7 — 21 2 SECTION 10-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L o, 152,-§25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... No...... ❑ ke � ' A The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures.A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time,during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153(Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws andState of Massachusetts General Laws Annotated. Homeowner Signature r City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: The debris will be transported by: y The debris will be received by: Building permit number: Name of Permit Applicant � �►�-✓ �i�-� Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of Industrial Accidents 4 Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): 1��(^/ Address: L City/State/Zip: ,�„� c�Z Phone#: -5 7- Are you an employer? Che&the appropriate box: Type of project(required): 1.X I am a employer with�� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ 9. EJ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y � 1?• 12V Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.7 Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp_policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. ke— Policy Insurance Company Name:#or Self-ins. Lic. #: �� 2 U� r�qd 9 Z Expiration Date: Job Site Address: 7-,,,1 J_&•-,/ 2�7_1ele City/State/Zip: /f,(� i �4,�� /1! &�>/D 6 25 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sign re: Date: Z Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Stephen Camp Construction 46 East St. Easthampton, Ma 01027 (413)527-7124 Submitted To: Audrey Kieras Phone- 545-5647 Address : 43 Manhan Street Date 7-19-2019 Northampton Mass 01060 I hereby submit this estimate for- Roof Work To start I will strip the roof down to the boards. I will install all new drip edge and ice and water shield on the whole roof. The shingles will be certainteed life time warranty color- black There will be ridge vent on all peaks. of 2t bl0.ck Building permit and trash removal is included in my price. Materials = $3600.00 Labor = $ 4250.00 Total = $ 7850.00 Gutter repairs,metal trim work and vinyl siding repairs= $ 850.00 Contractor Supervisors License number 082531 Home Improvement contractor Registration number 135204 I propose to supply materials and labor-in accordance with above specifications. This proposal may be withdrawn By us if not accepted within 30 Days Authorized Signature Acceptance of proposal Signature f c i fa ;I „ E.jl7' L',i l�Js '• �' il; j� � .. '• i 4W" b t f t}Si'.� ..'; .1 ,�J.2.�.... ~•�,' �•��•� ny{� a k"���,((("""`�..` � - `: ')V"? z�!;:�a+Li'. .j'i 'd Tir;�)jfs '.1i,f;i.,,rT�',i r�t� r�jii^.'r.l•f"S'! `•BCCI �P:rl.;f,fi.j,RI�I ';;'.t•.� 1i�f.� .f�'"l�i; �U•r ' ...w.-...,.-.....-.....,.,..,► ................�....�..-..�,....�......_..._..,.�....�+.rte+........_......... _.... ..__............_ t.�1�. 43T:jr#�'•�:0 r' z -4Apc '."W K U7( _ • t:'t..' 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